Evaluation of splenic injury in blunt abdominal trauma by multidetector computed tomography

Abstract

Background Multidetector computed tomography (MDCT) has been evolved in the assessment of cases with blunt abdominal trauma. It can easily detect injuries to different abdominal viscera. Aim The current work aimed to evaluate the role of MDCT in the diagnosis of splenic injuries in patients with blunt abdominal trauma. Patients and methods Over a period from March 2019 to June 2019, 40 patients with different forms of splenic injuries were reviewed. The splenic injuries were diagnosed based on abdominal ultrasound, CT, and/or laparotomy if done. Results Of the studied patients, 85% were males. The mean age of all patients was 21.40 ± 14.39 years. The most frequent form of trauma was motor car accidents (42.5%). Based on CT, 17 (42.5%), 16 (40%), seven (17.5%), and two (5%) patients had splenic laceration, hematoma, shattered spleen, and vascular extravasation, respectively. All patients had intraperitoneal fluid collection. Moreover, grades I, II, III, IV, and V splenic injuries were presented in seven (17.5%), six (15%), 19 (47.5%), two (5%), and six (15%) patients, respectively. All patients with grades I, II, and III were conservatively managed, whereas those with grades IV and V were managed with splenectomy. Diagnosis by MDCT in 20% of patients was consistent with the final diagnosis in laparotomy, so diagnostic accuracy of MDCT was 100%. In 80% of patients, the management plan was conservative and follow-up ultrasound showed improvement of splenic injuries, which suggests that the diagnosis of MDCT was correct. Conclusion MDCT has become the imaging modality of choice for evaluation of blunt splenic injuries and provides accurate diagnosis, including injury grades, associated active bleeding, and/or other visceral injury, which is helpful in determining the proper plan for successful management strategy and decreasing the rate of unnecessary exploratory laparotomy.